Healthcare Provider Details

I. General information

NPI: 1245737121
Provider Name (Legal Business Name): SHANNON BARRY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 ORANGE PL STE 2100
BEACHWOOD OH
44122-8400
US

IV. Provider business mailing address

3909 ORANGE PL STE 2100
BEACHWOOD OH
44122-8400
US

V. Phone/Fax

Practice location:
  • Phone: 216-896-1800
  • Fax:
Mailing address:
  • Phone: 216-896-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberR159933
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR159933
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.025728
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP.025728
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: